Public Health and Primary Care Collaboration: Interactional Factors Influencing Capacity Building

We compared the work settings and “community-oriented clinical practice” of Community Medicine (CM) specialists and family physicians/general practitioners (FP). We conducted secondary data analysis of the 2004 National Physician Survey (NPS) to examine main work setting and clinical activity reported by 154 CM (40% of eligible CM in Canada) and 11,041 FP (36% of eligible FP in Canada). Text data from the specialist questionnaire related to “most common conditions that you treat” were extracted from the Master database for CM specialists, and subjected to thematic analysis and coded. CM specialists were more likely than FP to engage in “community medicine/public health” (59.7% vs 15.3%); while the opposite was found for primary care (13% vs. 78.2%). CM specialists were less likely to indicate a main work setting of private office/clinic/community health centre/community hospital than were FP (13.6% vs. 75.6%). Forty-five percent of CM provided a response to “most common conditions treated” with the remainder either leaving the item blank or indicating that they did not treat individual patients. The most frequently named conditions in rank order were: psychiatric disorders; public health program/activity; respiratory problems; hypertension; and metabolic disorders (diabetes). There is some overlap in the professional activities and work settings of CM specialists and FP. The “most commonly treated conditions” suggest that some CM specialists may be practicing primary care as part of the Royal College career path of “community-oriented clinical practice.” However the “most commonly treated conditions” do not specifically indicate an orientation of that practice towards “an emphasis on health promotion and disease prevention” as also specified by the Royal College for that CM career path. This raises questions about the appropriateness of the current training requirements and career paths as delineated for CM specialists by the Royal College of Physicians & Surgeons of Canada. Bhopal R. Public health medicine and primary health care: convergent, divergent, or parallel paths? J Epidemiol Community Health 1995; 49:113-6. Pettersen BJ, Johnsen R. More physicians in public health: less public health work? Scan J Public Health 2005; 33:91-8. Stanwell-Smith R. Public health medicine in transition. J Royal Society of Medicine 2001; 94(7):319-21.

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Linkage to primary-care public health facilities for cardiovascular disease prevention: a community-based cohort study from urban slums in India

BMJ Open ◽

10.1136/bmjopen-2020-045997 ◽

2021 ◽

Vol 11 (8) ◽

pp. e045997

Author(s):

Abhijit Pakhare ◽

Ankur Joshi ◽

Rasha Anwar ◽

Khushbu Dubey ◽

Sanjeev Kumar ◽

...

Keyword(s):

Public Health ◽

Primary Care ◽

Multivariate Analysis ◽

Urban Slum ◽

Primary Care Providers ◽

Health Facilities ◽

Care Providers ◽

Community Based ◽

Public Health Facilities ◽

Care Facilities

ObjectivesHypertension and diabetes mellitus are important risk factors for cardiovascular diseases (CVDs). Once identified with these conditions, individuals need to be linked to primary healthcare system for initiation of lifestyle modifications, pharmacotherapy and maintenance of therapies to achieve optimal blood pressure and glycaemic control. In the current study, we evaluated predictors and barriers for non-linkage to primary-care public health facilities for CVD risk reduction.MethodsWe conducted a community-based longitudinal study in 16 urban slum clusters in central India. Community health workers (CHWs) in each urban slum cluster screened all adults, aged 30 years or more for hypertension and diabetes, and those positively screened were sought to be linked to urban primary health centres (UPHCs). We performed univariate and multivariate analysis to identify independent predictors for non-linkage to primary-care providers. We conducted in-depth assessment in 10% of all positively screened, to identify key barriers that potentially prevented linkages to primary-care facilities.ResultsOf 6174 individuals screened, 1451 (23.5%; 95% CI 22.5 to 24.6) were identified as high risk and required linkage to primary-care facilities. Out of these, 544 (37.5%) were linked to public primary-care facilities and 259 (17.8%) to private providers. Of the remaining, 506 (34.9%) did not get linked to any provider and 142 (9.8%) defaulted after initial linkages (treatment interrupters). On multivariate analysis, as compared with those linked to public primary-care facilities, those who were not linked had age less than 45 years (OR 2.2 (95% CI 1.3 to 3.5)), were in lowest wealth quintile (OR 1.8 (95% CI 1.1 to 2.9), resided beyond a kilometre from UPHC (OR 1.7 (95% CI 1.2 to 2.4) and were engaged late by CHWs (OR 2.6 (95% CI 1.8 to 3.7)). Despite having comparable knowledge level, denial about their risk status and lack of family support were key barriers in this group.ConclusionsThis study demonstrates feasibility of CHW-based strategy in promoting linkages to primary-care facilities.

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Who manages health workforce in the States of India: Profile, knowledge and perceptions of the team

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.664 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

S Khurana ◽

S Roy ◽

M Gupta

Keyword(s):

Public Health ◽

Capacity Building ◽

Human Resource ◽

Health Workforce ◽

Health Sector ◽

Limited Resource ◽

Role Clarity ◽

Public Health Sector ◽

Hrm Practices ◽

Significant Difference

Abstract Problem Human resources in the public health sector is of prime importance in a limited resource setting country, who at times work in a high-pressure, limited resource environment and where skilled staff continue to remain in short supply. The role of Human Resource for Health (HRH) team responsible for managing this health workforce is crucial. They play an important role in improving the human resource practices and creating an enabling organizational culture for optimal resource utilization. The paper explores the profile of the HRH teams of the states of India, their knowledge levels, and perceptions of their role. Methods The participants were HR Managers from 29 states of India who look after HRH in National Health Mission and State Health Departments. Cross-sectional survey tool was used for data collection. Quantitative data analysis included univariate and bivariate analysis. One Way ANOVA test of significance and post-hoc tests using Tukey's method was used to ascertain the groups with significant difference. Results Most of the HRH team members are postgraduates or have management background. Their experience varies from <1year to > 25 years. Mostly of them perceive their role to be limited to implementing bare essential HRM practices, mostly administrative. The educational qualification of the members did not have any significant bearing on their technical knowledge related to HRM practices; but their experience in public health sector showed a significant association. Lessons This study lends evidence to the principle that professionals who have been in the system for long, know about HRH and the associated policies better, and hence may be better equipped to handle HRH and establish good HR Management (HRM) systems. Better role clarity among the HRH teams, expansion of their current scope of work to include advanced practices of HRM and continuous capacity building mechanisms are needed to help strengthen the development and management of HRH. Key messages This study, a first of its kind in the country, lend evidence related to the principle for deciding the profile of team who should be entrusted with managing and development of HRH. The Study gives evidence to focus on the role clarity of HRH to zero down their knowledge and skills gaps and enhance their competencies through better capacity building.

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Geospatial analysis of emergency services use for public health assessment and intervention

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1129 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

G Cassourret

Keyword(s):

Public Health ◽

Primary Care ◽

Unemployment Rate ◽

Emergency Services ◽

Health Interventions ◽

Healthcare Provision ◽

Socioeconomic Determinants ◽

Primary Care Doctors ◽

Use Of Emergency Services ◽

Neighborhood Level

Abstract The population is increasingly using emergency care services around the world. The underlying interrogation is whether this increase is a consequence from a dysfunction in healthcare provision, from a deterioration in the health status of the population or from socioeconomic determinants. We performed geospatial analyses with 3-year 1,081,026 Emergency Medical Services (EMS) responses in Paris and its suburbs. Incidence of calls per population and complaints were compared, at the neighborhood level, with demographic and socioeconomic determinants. Associations with characteristics of the health system such as the density of primary care doctors were also studied. Spatial autocorrelations were searched with Moran's I analyses. We found a positive correlation between the incidence of EMS calls by population for respiratory problems, and the level of poverty as well as the unemployment rate (p < 0.001). There was no significant correlation between psychiatric complaints and socioeconomic determinants. There was a strong correlation between calls for birth or imminent birth by woman of childbearing age and the unemployment rate among women, the unemployment rate overall and household median household income (p < 0.001). There was no correlation between the density of primary care providers and EMS activity by population. EMS data allowed us to powerfully identify specific socioeconomic determinants of health for a 7 million-inhabitant population at the district level. Results could be used to design and implement tailored public health interventions for maximum impact. The overuse of emergency services does not seem to stem solely from the decrease in the supply of primary care doctors. Innovatively, monitoring the actual use of emergency services could responsively inform policy makers and agencies responsible for prevention and health promotion about the specific needs of the population and the consequences of decisions on the organization of the provision of care. Key messages The use of emergency services is a valid metric to evaluate the health status of the population and identify socioeconomic determinants. It gives specific guidelines for public health interventions. Geospatial analyses can efficiently identify the specific needs of a population at the neighborhood level. It can participate to the evaluation of the organization of healthcare provision.

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